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Stability and priority of symptoms and symptom clusters among allogeneic HSCT patients within a 5-year longitudinal study.

Stability and priority of symptoms and symptom clusters among allogeneic HSCT patients within a 5-year longitudinal study.
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Esser P, Kuba K, Scherwath A, Johansen C, Schwinn A, Schirmer L, Schulz-Kindermann F, Kruse M, Koch U, Zander AR, Kröger N, Götze H, Mehnert A,


Esser P, Kuba K, Scherwath A, Johansen C, Schwinn A, Schirmer L, Schulz-Kindermann F, Kruse M, Koch U, Zander AR, Kröger N, Götze H, Mehnert A, (click to view)

Esser P, Kuba K, Scherwath A, Johansen C, Schwinn A, Schirmer L, Schulz-Kindermann F, Kruse M, Koch U, Zander AR, Kröger N, Götze H, Mehnert A,

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Journal of pain and symptom management 2017 07 12() pii S0885-3924(17)30275-0
Abstract
CONTEXT
Due to toxicity and invasiveness, allogeneic HSCT causes severe and longstanding symptom burden. Longitudinal studies on symptoms and symptom clusters (SC) would be helpful to optimize symptom control, but are rare to date.

OBJECTIVES
To investigate stability of symptoms, extract time stable SC and to determine their priority in symptom management.

METHODS
In this multicenter study, patients diagnosed with hematological cancer were assessed before conditioning (T0) and three months (T1), one year (T2) and five years (T3) after transplantation. Symptoms were assessed with the EORTC-QLQ-C30. Symptoms were stable when rated as present at three consecutive time points. Applying factor analysis, stable SC were composed of symptoms loading on the same factor across all time points. Priority in symptom management was derived from a combination of severity and predictive power for quality of life (QoL).

RESULTS
239 patients participated at T0, 150 (63 %) at T1, 102 (43 %) at T2 and 45 (19 %) at T3. We identified three stable SC, composed of rest-tired-weak-dyspnea-loss of appetite (exhausted), tense-worried-irritable-depressed (affective) and nausea-vomiting (gastrointestinal). Fatigue was most persistent, and also most severe and predictive for QoL, both as symptom and in cluster (exhausted).

CONCLUSIONS
Given its high stability, severity and impact on QoL, fatigue should have priority in symptom management. The treatment of this symptom could be enhanced by also incorporating interventions addressing dyspnea and loss of appetite.

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